Five years ago, Mina Breuker of Holland Home and Teresa Toland of Porter Hills sat on a panel with other nursing home administrators to tackle the problem of hospital readmissions. Examining root causes, they realized “the problem is bigger than transition of care,” Toland recalls.
Case in point: Henry, an 80-year-old patient, socially isolated and unable to manage his medications or get to appointments. Toland and her colleagues pondered, “How could we close the gaps and create interventions for someone like Henry?”
The solution: Tandem365
People like Henry were lost in a fragmented system where “no one was holding the story of the patient,” Breuker says.
Their solution? Form a joint venture — Tandem365 — to deliver complex care management services to vulnerable seniors. The business model hinges on a role that has worked for other case management programs: the navigator. Each Tandem365 team includes a social work navigator and a nurse navigator.
Tandem delivers better care at lower costs, using:
- A robust network of volunteers, visiting with clients and doing chores
- Paramedics, providing care in patients’ homes whenever necessary
- An interdisciplinary team, meeting daily to discuss activity with current members (such as after-hours calls) and new enrollments
This team works with each participant to create a life plan, coordinating with family members and healthcare providers to advocate for that person.
In early 2014, Tandem365 piloted a project with commercial payer Priority Health. Priority targeted their most expensive members first — those costing over $25,000 per year.
The results are encouraging. Among the 150 pilot members, by the end of 2015, Tandem365 found:
- Average healthcare cost per member — down 30.2 percent
- ER visits — down 46.2 percent
- Specialty visits — down 22.8 percent
- Outpatient visits — down 13.4 percent
One roadblock: Not everyone agrees to participate. “Sometimes it’s hard to convince someone that they need something, even when it’s free,” says Toland, who is CEO of Tandem.
Tandem has improved its conversion rate to about 70 percent, up from 50 percent, largely due to a strong network of case managers.
Tandem has improved its conversion rate to about 70 percent, up from 50 percent, largely due to a strong network of case managers. Toland projects Tandem will hit 537 participants by year’s end, up from 302 in March. With such strong growth, and 98 percent client satisfaction, Tandem and Priority recently entered a three-year contract.
Currently, Tandem365 receives from Priority a per-member-per-month (PMPM) payment of $625 for its care management services, but it plans to move toward risk sharing. The tipping point will be “once we know for sure that we are impacting outcomes,” Toland says. To reach that point, Priority must identify a cohort of people against which they can measure the Tandem population — a challenge, “because our people have a lot of social determinants that don’t show up on claims.”
Keys to success
Meanwhile, the pilot’s success is yielding more opportunities. Tandem is starting a pilot program with health maintenance organization Blue Care Network of Michigan that will target 100 eligible members.
Tandem365’s keys to success so far:
- Custom training. Tandem University, taught by two professors from Grand Valley State University, provides training on topics such as aging, discrimination, and creating a life plan. “We found through our pilot that we have to prepare our staff very differently,” Breuker says. The focus is on enabling members’ independence. “It’s so much broader than healthcare.”
- Financial accountability. Team members must balance financial realities with client needs. An electronic scorecard highlights how much money each team has for the month.
- Collaboration. Breuker and Toland encourage other senior care providers to collaborate — even with competitors — to solve common problems together. That way, “you have a lot more power and ability to learn best practices from each other.”